Provider Demographics
NPI:1255520763
Name:OTTNEY, LORRAINE MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:LORRAINE
Middle Name:MARIE
Last Name:OTTNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1405
Mailing Address - Country:US
Mailing Address - Phone:419-874-1839
Mailing Address - Fax:
Practice Address - Street 1:314 W 2ND ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1405
Practice Address - Country:US
Practice Address - Phone:419-874-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-21
Last Update Date:2007-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH062364164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse